Child Maltreatment Reporting Form

Date of Report: 12/5/2019

If you feel this child(ren) is in immediate danger, please call 911. If you are unsure and/or would prefer to speak to a Child Protection social worker, please call Anoka County Child Protection at 763-324-1440 and a social worker will assist you with your report.


Child

Please provide as much information about the child as possible


Click To Add Other Children Living In The Home

Parent

Please provide as much information about the parent as possible


Alleged Perpetrator

Please provide as much information about the alleged perpetrator as possible

Reporter

Please provide as much information about the reporter as possible


Am I a mandated reporter?


Reason For Referral

Please provide a reason for referral. Please include conditions, dates, descriptions of injury, statements of child, etc.

*

Attach Files

You may Choose a image, word or pdf file. Click the Attach Selected File button to submit documents with your referral.




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Submit Form

Mandated Reporters are people who work in a number of professions, including health care, social services, psychological treatment, child care, education, corrections, law enforcement, and clergy who are required to report suspected child maltreatment.

Please wait, it may take a few minutes for the form to process.